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Semin Thromb Hemost 2023; 49(04): 355-363
DOI: 10.1055/s-0042-1754391
Review Article

Pregnancy Related Venous Thromboembolism-Associated with HIV Infection and Antiretroviral Therapy

Elise Schapkaitz
1   Department of Molecular Medicine and Hematology, University of Witwatersrand, Johannesburg, South Africa
,
Barry F. Jacobson
1   Department of Molecular Medicine and Hematology, University of Witwatersrand, Johannesburg, South Africa
,
Elena Libhaber
2   Department of Research Methodology and Statistics, University of Witwatersrand, Johannesburg, South Africa
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Abstract

Human immunodeficiency virus (HIV) infection in pregnancy is associated with substantial morbidity and mortality. Improved access to effective antiretroviral therapy (ART) has shifted the spectrum of pregnancy-related complications among HIV-infected pregnant women. In addition to placental vascular complications and preterm delivery, increased rates of venous thromboembolism (VTE) have been described. HIV infection is characterized by immune activation, inflammation, and endothelial dysfunction, which contribute to the activation of coagulation and its prothrombotic consequences. Indeed, activated coagulation factors have been reported to be increased and natural anticoagulants reduced in HIV. Several mechanisms for this persistent prothrombotic balance on ART have been identified. These may include: co-infections, immune recovery, and loss of the gastrointestinal mucosal integrity with microbial translocation. In addition to the direct effects of HIV and ART, traditional venous and obstetric risk factors also contribute to the risk of VTE. A research priority has been to understand the mechanisms of VTE in HIV-infected pregnant women receiving suppressive ART and to translate this into HIV-specific thromboprophylaxis recommendations. Management requires a multidisciplinary approach and further studies are indicated to guide the prevention and management of pregnancy-associated VTE in this population. The current review describes the epidemiology, mechanisms, and management of VTE in HIV-infected women in pregnancy and the postpartum period.

Keywords

human immunodeficiency virus - pregnancy - venous thromboembolism

Authors' Contributions

All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication. E.S. wrote the original draft. E.S., B.F.J., and E.L. reviewed and edited the manuscript.




Publication History

Article published online:
02 September 2022

© 2022. Thieme. All rights reserved.

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